Losing Weight Matters

When people launch themselves earnestly into a weight-loss program, their motivations are most commonly things like improving appearance, having more energy and other readily noticeable factors.

The doctors that might have encouraged them to embark on a fat-reduction program may be more precisely concerned with things like lowering blood pressure and reducing disease risk factors.

We've known for a while that improvements in the standard measures can be enjoyed by all weight losers, including those who do not attain the slim silhouette they may have desired when they started. Even a 10 percent loss of body weight can mean significant health improvements.

But there is some intriguing evidence that seems to indicate that it's not just that you're likely to have better blood pressure at a lower body weight, or that shedding some of the excess body fat can actually improve some of your blood chemistry. Apparently, there are health benefits to be gained from losing weight, the actual process of losing, even distinct from being at the eventual lighter weight achieved.

Now, that might seem like an inseparable distinction. You can't very well get to a lighter body mass index without losing some weight. But here's the thing: when researchers examined overweight people of a certain body mass index, the ones who had dropped pounds to get into that weight class were overall healthier than the ones who had gained their way into it, even though they were all still overweight!

Well, then what do we mean by healthier? There are so many problems associated with being overweight, things like hypertension, diabetes, coronary artery disease, hyperlipidemia (high blood fats), osteoarthritis, sleep apnea, breathing problems, gall bladder disease, and psychological disorders like depression. Doctors call these comorbidities, because they can be tracked distinct from the weight excess, even though they're related.

You can take your pick of relevant tests to see if there's been an improvement in comorbidities. Of course there's blood pressure and blood sugar and lipid levels; you can examine insulin production and whether it's too high or low; you can test cholesterol levels, track sleeping and breathing patterns. And then there are subjective measures like how a person feels, or even feels about themselves. Most of these measures as well as a few others were used for this study.

Here's how they figured it all out. The research was done in Australia, with a very carefully selected group of participants, all people who were roughly matched by age and size, with a stable BMI (body mass index) between 30 and 35, which is the range for the definition of clinical obesity. On a person who is 5-foot, 9-inches in height, that's up to about 235 pounds.

Half these people were patients of gastric banding surgeries who had already lost a lot of weight, in some cases, up to 100 pounds. Most people following gastric banding lose 50 to 60 percent of their excess weight by about two years after surgery. The subjects in this study were three-years post-surgery and had basically quit losing weight and stabilized in the 30 to 35 BMI range.

Now, the conventional wisdom would anticipate that people in that BMI range would experience all the usual health problems that are associated with obesity and the comorbidities listed above. But no! The researchers reported that these still-heavy-but-less- heavy-than-before folks were able to achieve major improvements in their comorbidities and overall quality of life such that they were "similar to normal."

In fact, the researchers admitted a certain puzzlement when they reported that the subjects' "continued state of obesity should be driving a compromised state of health and quality of life, and yet, the data indicate that the benefits of weight loss seem to override the harm of obesity."

So then they matched them with a group of controls who had not yet undergone any weight-loss program, people who were also 30-35 BMI, but prior to any effort to reduce.

When the investigators compared the health and quality-of-life indicators between the two groups, they found that the weight-loss group fared much better than the controls on almost every measurement. The weight-loss subjects had lower blood sugar and insulin levels, and better insulin sensitivity levels than the controls. The conventional measures of blood lipids associated with overweight were also more favorable in the weight-loss subjects, who had lower triglycerides, higher high-density-lipoprotein (HDL) cholesterol (that's the good cholesterol), and lower total cholesterol. All of those measures are markers of the metabolic syndrome, which most people know is a red-flag precursor to diabetes.

Overall, 38 percent of the control group had metabolic syndrome, compared to only 14 percent of the weight-loss group.

There were some measures that didn't offer any significant distinctions, such as specific body measurements, and blood pressure was about the same; hemoglobin levels and iron status were also pretty consistent.

On the mental/emotional side, the weight-loss subjects scored better than the controls for all the measures of quality of life, symptoms of depression and perception of appearance, including physical function, pain, general health, energy or vitality, social function and mental health. Probably no surprise there, while they were all about the same weight, for the weight-loss subjects, that weight was an improvement, whereas for the control group, it was likely the result of a long losing struggle against gain.

The researchers decided their results mean that they need to look more closely at the expectations of weight-loss therapies in general, but what it should say to the heavy person is "atta boy!" You may not have to be as slim as "average" folks to be as healthy, so don't psyche yourself out of an effort by thinking that before you even start.

Because there is one other interesting note. The weight-loss group also scored slightly higher on self- assessed quality-of-life indicators than the population at large, suggesting that the loss of weight in and of itself improved these folks' mental health, even though they were still heavier than the population average.

Of course, when you get down to it, that's probably not a surprise either. They might not have reached the body weight they'd always dreamed of, but they'd seen tremendous improvements, no doubt inspiring hope and optimism in general, and nothing succeeds like success, even when there's still an excess.

Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physicians (the medical specialty of weight management). She specializes in lifetime weight management at the Cederquist Medical Wellness Center.